NUR 2310 PSYCH MEDS UPDATED 2022 | NUR 2310 Study Guide

NUR 2310 PSYCH MEDS UPDATED 2022 | NUR 2310 Study Guide. Benzodiazepine anxiolytics: [Controlled substance IV]  diazepam (Valium)  alprazolam (Xanax)  lorazepam (Ativan)  chlordiazepoxide (Librium)  oxazepam (Serax)  clonazepam (Klonopin)  clorazepate (Tranxene) IV Benzodiazepines are Diazepam and lorazepam For IV toxicity, administer flumazenil (Romazicon) to counteract sedation and reverse side effects Klonopin Wafer disintegrating tablet was discontinued in US. Action: enhances the inhibitory effects of gammaaminobutyric acid in the Central nervous system. Relief from anxiety occurs rapidly after administration. Therapeutic Uses: First-line treatment for generalized anxiety disorder and panic disorder  Quick onset of action  Potential for dependence  Ideally used short term, only until other medication or treatment reduces symptoms.  Important for nurse to monitor side effects  Avoid pregnancy because of risk of congenital anomalies  Do not breast feed  Avoid caffeine because it decreases desired effects of drug  Avoid alcohol and other antianxiety drugs because depressant effect would be potentiated.  Cessation after 3-4 months use may cause withdrawal symptoms: insomnia, irritability, nervousness, dry mouth, tremors, convulsions, and confusion.  Take medicine with or shortly after meal to reduce GI discomfort.  Do not discontinue abruptly  For oral toxicity, gastric lavage is used, followed by administration of activated charcoal or saline cathartics  After taking high doses of benzodiazepines, patient should be tapered off to avoid withdrawal effects  Sedation  Light-headedness  Ataxia  Decreased cognitive function  Paradoxical response: insomnia, excitation, euphoria, anxiety, rage Complications  CNS Depression  Anterograde amnesia - difficulty recalling events that occur after dosing  Acute toxicity - Oral toxicity symptoms are drowsiness, lethargy, confusion. IV toxicity symptoms are respiratory depression, severe hypotension, and cardiac arrest  Withdrawal response – anxiety, insomnia, diaphoresis, tremors, lightheadness, delirium, seizures  Cautions/Contraindications Caution in patients with  Substance abuse  Liver disease Contraindicated in patients with  Glaucoma  Sleep apnea  Respiratory depression Buspirone (BuSpar): Used for treatment of general anxiety disorder (GAD) Action: Binds to serotonin and dopamine receptors. Increases norepinephrine metabolism in brain. Therapeutic Uses: Panic disorder, OCD social anxiety disorder, generalized anxiety disorder OTHER MEDS USED FOR ANXIETY DO: BETA BLOCKERS: Propanolol CENTRALLY ACTING ALPHABLOCKERS: Prazosin ANICONVULSANTS: Gabapentin ANTIHISTAMINES: Nursing Interventions Side Effects  Alternative that does not cause dependence  Takes 2–4 weeks to reach full effect [ATI: 2-6 weeks for full effects] . During this period there is a very high rate of suicidality.  May be used for long-term treatment  Must be taken regularly at same time  Not recommended for nursing mothers  Do not use concurrently with erythromycin, ketoconazole; avoid drinking grapefruit juice.  Teach patient to avoid herbal preparations containing St. John’s Wort  Advise patient to take with food to avoid to prevent gastric irritation  Dizziness, drowsiness, excitement, fatigue, headache, insomnia, nervousness, weakness.  Blurred vision, nasal congestion, sore throat, tinnitus  Nausea, vomiting  Clamminess, sweating Complications/Precautions  Pregnancy category B risk  Not recommended in women who are breastfeeding  Use cautiously in older adults or patients with renal problems  Concurrent use with MA  OI, or for 14 days for after MAO has been discontinued, hypertensive crisis can occur. 1 of 7 Anxiolytics Drugs Nursing Interventions Side Effects This study source was downloaded by from CourseH on :05:13 GMT -05:00 Psychiatric Medications Benadryl, atarax. Complementary Remedies : KAVA KAVA, Valerian  Avoid with grapefruit, b/c levels of med to increase Antidepressants SSRIs (Selective serotonin reuptake inhibitors): Now considered first choice for depression. SSRI antidepressants are the first-line treatments for panic disorders and trauma- and stressorrelated disorders.  fluoxetine (Prozac)  citalopram (Celexa)  fluvoxamine (Luvox)  escitalopram oxalate (Lexapro)  paroxetine (Paxil) one of the most effective  sertraline (Zoloft) Action: These drugs preferentially block the reuptake and thus the destruction of serotonin, with little or no effect on the other monoamine transmitters. Also used successfully in :  Depressive disorders  Anxiety disorders including panic disorder, social phobia, OCD, GAD, PTSD & SAD.  PMDD  Eating disorders  Sleeping disorders  Alcoholism  Schizophrenia  Do EKG because cardiac arrhythmias are a possibility.  Teach patient to minimize anticholinergic side effects by: - sipping fluids, chewing gum, and sucking on hard candy to decrease dry mouth. - avoiding hazardous activities if visual disturbances occur. - wearing sunglasses outside to prevent photophobia. - voiding just before taking medication to minimize urinary retention. - increasing intake of fiber and fluids to prevent constipation. - avoiding strenuous exercise in warm weather due to the suppression of sweating. - Change positions slowly to minimize dizziness from orthostatic hypotension.  Encourage pt to participate in regular exercise and to follow a healthy low-calorie diet.  Contraindicated for clients taking MAOIs  If patient will be given MAOI, there must be at least two weeks in between.  SSRIs have a long half-life which may take up to 6 weeks to take effect  Give in morning to avoid insomnia.  Avoid abrupt discontinuation of the medication. Dose should be tapered.  Patient should avoid alcohol and caffeine while taking SSRI.  Use cautiously in patients who have bipolar disorder, due to risk of mania. SSRIs such as fluoxetine may be used cautiously to manage a major depressive episode.  Use cautiously in patients who have a history of GI bleeding and  Weight gain is very common  Anticholinergic side-effects (blurred vision, dry mouth, constipation, urinary retention, tachycardia); have pts drink lots of water.  Sexual dysfunction (absent orgasm, impotence, decreased libido) Report this symptom to the provider if it is intolerable.  Hyponatremia (more likely in adults on diuretics)  Rash  Anxiety and sleeplessness  Prozac is contraindicated in patients taking MAOIs.  Prozac can result in increased warfarin levels. (Monitor client’s PT and INR)  Paroxetine causes CNS stimulation, which can cause insomnia.  Early adverse side effects for the first few days/weeks: nausea, diaphoresis, tremor, fatigue, drowsiness. Report adverse effects to provider. Continue to take medication, these effects should soon subside.  Bruxism may occur. Use a mouth guard.  Report indications of bleeding (darks stools, emesis that look like coffee grounds)  SEROTONIN SYNDROME: can begin 2-72 hr after starting treatment and can be lethal. Manifestations: confusion, agitation, poor concentration, disorientation, delirium, seizures, tachycardia, labile BP, fever, incoordination that can lead to hyperreflexia, nausea, vomiting, diarrhea, and abdominal pain; coma leading to apnea.  If any of the symptoms for serotonin syndrome occur, then withhold medication and notify. We offer online tutoring and help with class assignments for all modules and majors with a guaranteed pass. For assistance contact Alpha Tutors: